Diabetic retinopathy relates to the incidence of foot ulcers and amputations in type 2 diabetes

Abstract

Aims We investigated whether Diabetic Retinopathy (DR) is related to Diabetic Foot Ulcer (DFU) development, adjusted for the stratification of the International Work Group on Diabetic Foot (IWGDF) guidance. Materials and Methods DR and IWGDF stratification was registered retrospectively in patients hospitalised from 2009 to 2017 for uncontrolled and/or complicated type 2 diabetes. New DFUs were registered until 2020. Survival analyses categorised the subjects for DR, and multivariate Cox regression adjusted for confounders. Results The 522 patients (57.9% male) were 62 ± 9 years old with a diabetes duration of 14 ± 10 years, HbA1c of 8.7 ± 1.8%, 33.9% macroangiopathies and 44.8% diabetic kidney diseases. Their grades of DFU risk were 0 for 43.3%, 1 for 23.9%, 2 for 7.1%, and 3 for 25.6%. During the 52 months follow‐up (Inter Quartile Range: 32–71), 58 new DFUs and 18 lower‐limb amputations occurred, mostly in patients with DR present in 140 (26.8%) patients. Adjusted for age, sex and conventional risk factors (duration and control of diabetes, arterial hypertension, and dyslipidemia), and other complications (macroangiopathy and diabetic kidney disease), DR was associated with a greater incidence of DFUs. Adjusted for the IWGDF classification, DR was related to new DFUs (HR: 2.51, 95%Confidence Interval [CI]: 1.48–4.26) and amputations (HR: 3.56, 95%CI: 1.26–10.07). This relationship persisted in ascending IWGDF grades with incidences of DFUs from 2/1000 (grade 0, no DR) to 121/1000 patient‐years (grade 3 and DR) and amputations from 0 (grade 0, no DR) to 38/1000 patient‐years (grade 3 and DR). Conclusions Diabetic retinopathy independently relates to the incidence of foot ulcers and amputations in patients hospitalised for type 2 diabetes.

Association between diabetic retinopathy and diabetic foot ulcer in patients with diabetes: A meta‐analysis

“…9 Both DR and DFU are closely associated microvascular complications of DM. Research has shown that there is a positive correlation between the incidence of DFU and DR. 10,18 The results of a study published by Gu et al indicated that microvascular disease in diabetes is positively correlated with the occurrence of DFU, and the risk of DFU in patients with diabetes and DR is significantly increased, which is consistent with the findings of this study. 25 The present study shows that DR can significantly increase the incidence of DFU.…”

“…Based on the titles and abstracts, 331 irrelevant articles were excluded, leaving 96 articles. After reading the full text and applying the inclusion and exclusion criteria, 11 articles were finally included with a total of 10 208 patients, including 2191 in the DFU group and 8017 in the non‐DFU group 9–19 . The screening process is shown in Figure 1.…”

“…After reading the full text and applying the inclusion and exclusion criteria, 11 articles were finally included with a total of 10 208 patients, including 2191 in the DFU group and 8017 in the non-DFU group. [9][10][11][12][13][14][15][16][17][18][19] The screening process is shown in Figure 1. The basic characteristics of the included studies are summarised in Table 1.…”

Clinical and Metabolic Profile of Diabetic Patients With Supracondylar Amputation

“…(16) Likewise, a study conducted in 522 patients found a relationship (HR: 3.56, 95%CI: 1.26-10.07) between diabetic retinopathy and amputations. (17) These results are similar to those obtained in several studies (18,19).…”

Gender difference as the risk of diabetic foot ulcers in T2DM patients: a meta-analysis

“…The chronic and refractory skin injuries such as diabetes foot ulcers (DFU) have become a health problem affecting the diabetes patients life quality [18]. Prevention and treatment of DFU is a multidisciplinary process [19].…”